From North Carolina, USA:
I am 29 years old and have Type 1 Diabetes. I was diagnosed about 8 years ago. My husband and I are planning to have a family and I have a few concerns. I would not describe my control in the past as poor, but I also would not say that my control was very good. I had an A1C about 3-1/2 months ago which was 8.0. (Prior to this, I was at 8.5, which is the highest results I have ever had.) I have been checking my blood sugar regularly, and have gained better control. A few weeks ago, I had an A1C test with a result of 6.5.
My doctor has put me on Humalog within the past 4 months, and I feel pretty good about the results; however, I am a bit concerned about the lack of information concerning potential dangers to the unborn child.
I am also curious about your recommendations about the frequency of blood sugar testing now and during pregnancy. I also have frequent fluctuations in my blood sugar (highs and lows), although the high readings are less frequent now than in the past. What are the dangers of such fluctuations (both high and low) to the unborn fetus? Does my recent A1C of 6.5 appear to be a "safe" level to attempt pregnancy? If safe, would it be better to wait another 3 months before attempting to get pregnant? My husband and I are concerned about the potential for birth defects and we want to take whatever precautions are necessary to minimize this risk.
Probably one of the most significant factors contributing to successful pregnancy outcome is preconceptual glucose control. Basically the closer that fasting and postprandial blood sugar values are to normal (I use below 105 mg/dl fasting, and less than 130 mg/dl at one hour postprandial as guidelines) the greater the likelihood that the risk of congenital abnormalities will be minimized. However, do not drive yourself crazy over an occasional elevated blood glucose value. Your recent hemoglobin A1C is very encouraging. I see no need to wait any additional time to try for a pregnancy as long as you maintain tight control of your blood sugar values.
During pregnancy the same blood glucose values are followed as I outlined above. This is especially critical during the embryonic period (conception to 9 weeks gestation). But is also important throughout pregnancy to prevent excessive growth of the fetus. Typically a Type 1 diabetic such as yourself will check a fasting blood sugar as well as prior to each meal. However, I often encourage my patients to check an occasional one hour post meal blood sugar as well. Insulin requirements may change dramatically during pregnancy and you should not worry if you find yourself taking more insulin as the pregnancy progresses. The frequent checking of blood glucose values will aid in determining your insulin needs and allow adjustments to be made in a timely fashion.
During pregnancy an occasional elevated blood sugar will not seriously affect the fetus. In fact, I worry more about repeated hypoglycemic episodes and the effects on the mother. Unfortunately, this is one of the trade-offs of tighther. Unfortunately, this is one of the trade-offs of tight glucose control.
Although Lilly does not recommend the use of lispro insulin [Humalog®] during pregnancy, there is no data as of yet that it poses any risk to the fetus. I have used Humalog during pregnancy if the mother had already been started prior to pregnancy or if the other types and combinations of insulin were not working. Therefore, if you are getting good results with Humalog, then I would suggest that you stick with it.
It is important that when you become pregnant that you obtain care from an obstetrician who is skilled in managing diabetes during pregnancy.
Original posting 10 Apr 97
Revised 15 Apr 97
Last Updated: Tuesday April 06, 2010 15:08:54
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